Angel Wings Care Home III

Allegation investigated: Staff failed to respect resident's privacy while in care

On 03/17/26 at 3PM, Licensing Program Analyst (LPA) D Panlilio conducted an unannounced complaint visit, met with staff (S1, S2) and spoke with administrator (ADM) on the phone who authorized S1 to act on her behalf and sign the reports. LPA gathered information and delivered investigation findings of above allegations to staff (ADM, S1, S2). LPA explained the purpose of the visit with staff (ADM, S1, S2). During investigation, LPA interviewed reporting party (RP), responsible party (DPOA), staff (S1, S2) and obtained the following documents from ADM - staff roster, residents’ roster, R1’s admission agreement, physicians report, ID/Emergency information, Needs & Services plan, After discharge summary report and incident reports. Continued on next page, LIC 9099-C Substantiated Allegation: Staff failed to respect resident’s privacy while in care Investigation Finding: Substantiated During investigation, LPA interviewed reporting party (RP), responsible party (DPOA), and staff (ADM, S1, S2). DPOA stated that on 11/06/25, resident (R1) was in her bedroom conversing via speaker phone with her. In the middle of their telephone conversation, staff (S1) physically went inside R1’s bedroom after eavesdropping on R1 and started interjecting in DPOA and R1’s telephone conversation, explaining why staff failed to provide timely service to R1. Review of audio recording dated 11/06/25 confirmed that staff failed to respect resident’s privacy while in care. Based on the department’s observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) that staff failed to respect resident’s privacy while in care was found to be substantiated. Deficiency is cited per Title 22 California Code of Regulations and listed on LIC9099D. Failure to submit proof of corrections (POC) by plan of correction due dates and/or any repeat deficiencies within a 12-month period may result in civil penalties. Exit interview conducted. Appeal Rights and a copy of this report provided. Allegation: Staff verbally abuse resident in care Investigation Finding: Unsubstantiated During investigation, LPA interviewed reporting party (RP), responsible party (DPOA), and staff (ADM, S1, S2). DPOA reported that staff (S1, S2) accused R1 of complaining to her family constantly about the food they prepare for her, that they even spend their own money to buy food for her, that the amount of money R1 pays for her stay at the facility is nothing because of the high cost of food and that she is a “ big problem for them”. DPOA stated staff commented to R1 on 03/02/26 that “We are not being paid enough to care for you. You constantly complain to your family that the food we serve you is no good.” DPOA stated that staff raised their voices at R1 even though she was wearing her hearing aids and could clearly hear them. DPOA stated that after R1’s encounter with S1 and S2 on 03/02/26, R1 stayed in her room feeling belittled, hurt and depressed. ADM talked with R1 about the incident the same day and followed up with S1/S2 who denied verbally abusing R1. S1, S2 stated that sometimes R1 does not wear her hearing aids which would require them to increase the volume of their voices so that she could hear them. Staff denied yelling at R1. LPA also interviewed other staff (S3) and residents (R2, R3) who did not witness staff yell or verbally abuse R1. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did occur, therefore the allegation that staff verbally abuse resident in care is unsubstantiated. Exit interview conducted and copy of report provided.the state’s words, verbatim · CDSS document, Mar 17, 2026 · control 15-AS-20260311144822

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.2(a)(1) · Plan of correction due date: Apr 13, 2026

In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (1) To have a reasonable level of personal privacy in accommodations, medical treatment, personal care and assistance, visits, communications, telephone conversations, use of the Internet, and meetings of resident and family groups. This requirement was not met as evidenced by staff failing to respect resident’s private telephone conversation which posed a potential health & safety risk to residents in care.the state’s words, verbatim · CDSS document, Mar 17, 2026

Plan of correction: By POC due date, administrator agreed to complete and submit in-service staff training by an accredited CCL vendor on residents’ personal rights in compliance with Title 22 Section 87468.2 (a)(1)

Type of visit: Case Management - Other

On 03/17/26 at 3:46PM, while at the facility for another reason, LPA D Panlilio observed that an uncleared and unassociated staff (S3) was working at the facility during visit. S3 stated she has not yet applied for fingerprint clearance, is not associated to the facility and has not completed the required 80 hours staff training prior to working at the facility. LPA advised staff (ADM, S1, S2) that S3 cannot stay and must leave the facility today. At 3:55PM, LPA spoke with administrator who confirmed S3 does not have the required fingerprint clearance, association to the facility and job training prior to start of work at the facility. Immediate civil penalty of $1,000 assessed during visit for absence of fingerprint clearance and association for S3. Deficiency is cited per Title 22 California Code of Regulations and listed on LIC9099D. Failure to submit proof of corrections (POC) by plan of correction due dates and/or any repeat deficiencies within a 12-month period may result in civil penalties. Exit interview conducted. Appeal Rights and a copy of this report provided.the state’s words, verbatim · CDSS document, Mar 17, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87411(g) · Plan of correction due date: Mar 17, 2026

Prior to employment or initial presence in the facility, all employees and volunteers subject to a criminal record review shall: (1) Obtain a California clearance or a criminal record exemption as required by law or Department regulations... This requirement was not met as evidenced by presence of uncleared, unassociated and untrained staff working at the facility which posed an immediate health & safety risk to residents in care.the state’s words, verbatim · CDSS document, Mar 17, 2026

Plan of correction: Immediate civil penalty of $1,000 assessed for one staff (S3) without criminal record clearance and association to the facility. LPA advised ADM that S3 cannot stay and must leave the facility asap.

Type of visit: Required - 1 Year

On 01/23/26 at 1:30PM, Licensing Program Analyst (LPA) D Panlilio arrived unannounced to conduct an annual required inspection. LPA met with administrator (ADM) and explained the purpose of the visit. ADM has current administrator certificate# 6070821740 which expires on 06/11/26. At 2PM, LPA toured the facility including but not limited to the front entrance, screening station, kitchen, bathrooms, bedrooms and common areas. There is one central entry point for universal screening for staff, clients and visitors. A sign-in policy, visitor’s logs, no touch thermometer, additional face masks and hand sanitizers were observed at the screening station. Emergency Disaster Plan, Complaint poster, Personal rights, Cough/sneeze etiquette, proper hand-washing signs were observed posted in common areas. Facility has a sufficient 2-day perishable and 7-day non-perishable food supply. Facility has a 30-day supply of PPEs, paper, medications locked in cabinets. Comfortable temperature is maintained at 73 deg F. Facility has a mitigation plan in place and the infection control leader is the administrator. Inside and outside pathways were free of obstruction and fire hazards. Smoke and Carbon monoxide detectors were operational. Updated copies of the following documents were collected for facility file:  LIC500- Personnel Report  Resident Roster  LIC308- Designation of Facility Responsibility  LIC610E- Emergency/Disaster Plan including infection control plans  Evidence of Liability Insurance Continued on next page, LIC 809-C At 2:15PM, LPA reviewed 3 staff and 5 resident files. Residents records contain Admission Agreements, Physicians' reports, Consent forms, Needs & Services Plans/Appraisals, Personal Rights and Safeguard of Property & Valuables. The facility has auditory signals on each sliding exit door. During visit, LPA observed the following deficiency: Open trash bin in the master bathroom Deficiency is cited per Title 22 California Code of Regulations and listed on LIC9099D. Failure to submit proof of corrections (POC) by plan of correction due dates and/or any repeat deficiencies within a 12-month period may result in civil penalties. Exit interview conducted, appeal rights and copy of report provided.the state’s words, verbatim · CDSS document, Jan 23, 2026

Allegation investigated: Staff allowed a resident to be soiled while in care Staff did not meet the needs of a resident while in care

On 06/04/25 at 12PM, Licensing Program Analyst (LPA) D Panlilio conducted an unannounced complaint visit, met with administrator (ADM), gathered information and delivered investigation findings of above allegations. LPA explained the purpose of the visit with ADM. During investigation, the department obtained the following documents from ADM - staff roster, residents’ roster, admission agreement, physicians report, ID/Emergency information, Needs & Services plan, Home health records and incident reports. Continued on next page, LIC 9099-C Substantiated Allegation: Staff allowed a resident to be soiled while in care Investigation Finding: Substantiated During investigation, LPA interviewed reporting party (RP), home health aide (HHA) staff (ADM, S1, S2). Staff (S1, S2, stated they did not find any issue with any resident on 05/22/25 while on duty from 7AM to 7PM. LPA confirmed with HHA that when she arrived on 05/22/25 at 7:30AM to provide care to R1, she found resident lying in bed horizontally with the head of the bed elevated to a sitting position and the foot of the bed also elevated to the highest point, creating a “V” position. HHA stated R1 had a soiled brief and bowel movement, with feces smeared on the bed, bed rails and on R1’s hair. HHA also stated R1 had torn the soiled bed linens to reposition herself or get out of bed. HHA stated she gave R1 a bath and changed her clothes that day. Based on the department’s observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) that staff allowed a resident to be soiled while in care was found to be substantiated. Allegation: Staff did not meet the needs of a resident while in care Investigation Finding: Substantiated During investigation, LPA interviewed reporting party (RP), home health aide (HHA) staff (S1, S2). HHA confirmed with LPA that when she arrived on 05/22/25 at 7:30AM to provide personal care to R1, she found R1 had a soiled brief and bowel movement, with feces smeared on the bed, bed rails and on her hair. HHA also stated R1 had torn the soiled bed linens to reposition herself or get out of bed. LPA interviewed staff (S1, S2) who stated that they were not aware that R1 had soiled herself in bed on 05/22/25. Based on the department’s observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) that staff did not meet the needs of a resident in care was found to be substantiated. Deficiencies are cited per Title 22 California Code of Regulations and listed on LIC9099D. Failure to submit proof of corrections (POC) by plan of correction due dates and/or any repeat deficiencies within a 12-month period may result in civil penalties. Exit interview conducted, appeal rights and copy of report provided.the state’s words, verbatim · CDSS document, Jun 4, 2025 · control 15-AS-20250528234401

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.2(a)(4) · Plan of correction due date: Jun 25, 2025

Residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs… This requirement was not met as evidenced by staff allowed resident to be soiled which posed a potential health & safety risk to residents in care.the state’s words, verbatim · CDSS document, Jun 4, 2025

Plan of correction: ADM agreed to have additional trained staff provide proper care and supervision to residents in care effective 06/04/25. By POC due date, ADM also agreed to complete and submit in-service staff retraining on proper care and supervision of residents by an accredited vendor in compliance with Title 22 Section 87468.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87411(d)(3) · Plan of correction due date: Jun 25, 2025

Skill and knowledge required to provide necessary resident care and supervision, including the ability to communicate with residents. This requirement was not met as evidenced by staff did not meet the needs of a resident while in care which posed a potential health & safety risk to residents in care.the state’s words, verbatim · CDSS document, Jun 4, 2025

Plan of correction: By POC due date, ADM agreed to complete and submit to CCLD in-service staff retraining on proper care and supervision by an accredited vendor in compliance with Title 22 Section 87411

Type of visit: Required - 1 Year

On 01/22/25 at 11:45AM, Licensing Program Analyst (LPA) D Panlilio arrived unannounced to conduct an annual required inspection. LPA met with administrator (ADM) and explained the purpose of the visit. ADM has current administrator certificate# 6070821740 which expires on 06/11/26. At 12PM, LPA toured the facility including but not limited to the front entrance, screening station, kitchen, bathrooms, bedrooms and common areas. There is one central entry point for universal screening for staff, clients and visitors. A sign-in policy, visitor’s logs, no touch thermometer, additional face masks and hand sanitizers were observed at the screening station. Emergency Disaster Plan, Complaint poster, Personal rights, Cough/sneeze etiquette, proper hand-washing signs were observed posted in common areas. Facility has a sufficient 2-day perishable and 7-day non-perishable food supply. Facility has a 30-day supply of PPEs, paper, medications locked in cabinets. Comfortable temperature is maintained at 72 deg F. Facility has a mitigation plan in place and the infection control leader is the administrator. Inside and outside pathways were free of obstruction and fire hazards. Smoke and Carbon monoxide detectors were operational. LPA reviewed 4 staff and 5 resident files. Continued on next page, LIC 809-C At 12:35PM, LPA reviewed 3 staff and 4 resident files. Staff had criminal record clearances to work and are associated to the facility. Residents records contain Admission Agreements, Physicians' reports, Consent forms, Needs & Services Plans/Appraisals, Personal Rights and Safeguard of Property & Valuables. The facility serves residents with Dementia. The facility has potentially dangerous objects locked and inaccessible to residents in care. The facility has auditory signals on each sliding exit door. Staff at the facility has the required Dementia training. During visit, LPA observed the following deficiencies: Hot water temperature measured at 127.3 deg F Updated copies of the following documents were collected for facility file:  LIC500- Personnel Report  Resident Roster  LIC308- Designation of Facility Responsibility  LIC610E- Emergency/Disaster Plan including infection control plans  Evidence of Liability Insurance Exit interview conducted and, appeal rights and a copy of this report provided.the state’s words, verbatim · CDSS document, Jan 22, 2025

Type of visit: Required - 1 Year

On 01/25/24 at 12PM, Licensing Program Analyst (LPA) D Panlilio arrived unannounced to conduct an annual required inspection. LPA met with administrator (ADM) and explained the purpose of the visit. ADM has current administrator certificate# 6040794740 which expires on 06/06/24. LPA toured the facility including but not limited to the front entrance, screening station, kitchen, bathrooms, bedrooms and common areas. There is one central entry point for universal screening for staff, clients and visitors. A sign-in policy, visitor’s logs, no touch thermometer, additional face masks and hand sanitizers were observed at the screening station. Emergency Disaster Plan, Complaint poster, Personal rights, Cough/sneeze etiquette, proper hand-washing signs were observed posted in common areas. Facility has a sufficient 2-day perishable and 7-day non-perishable food supply. Facility has a 30-day supply of PPEs, paper, medications locked in cabinets. Comfortable temperature is maintained at 72 deg F. Hot water temperature was measured at 117 deg F. Facility has a mitigation plan in place and the infection control leader is the administrator. Inside and outside pathways were free of obstruction and fire hazards. Smoke and Carbon monoxide detectors were operational. LPA reviewed 3 staff and 5 resident files. LPA also conducted 2 staff and 2 resident interviews during visit. Updated copies of the following documents were collected for facility file:  LIC500- Personnel Report  Resident Roster  LIC308- Designation of Facility Responsibility  LIC610E- Emergency/Disaster Plan including infection control plans  Evidence of Liability Insurance No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Jan 25, 2024